Management of stones in renal transplant.

PURPOSE OF REVIEW: Increasingly, screening of both deceased and living donor organs has led to the early detection of kidney stones prior to donation. A number of transplant recipients will still present with donor-gifted and de-novo stones. A range of treatment modalities is available in the management of renal transplant stones. RECENT
FINDINGS: Stones can be pretreated in the (living) donor prior to transplantation, managed at the time of transplantation or treated in the recipient post-transplant. The options include conservative management, extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy, ureteroscopy or open surgery depending on the size and location of the stone(s). Various techniques to deal with a transplant kidney are described. Ex-vivo ureteroscopy or pyeloscopy can safely render a kidney-stone free prior to transplantation and in living donors this means without subjecting the living donor to an additional stone removing procedure.
SUMMARY: The cause of renal transplant lithiasis is multifactorial. More research is needed to understand the factors associated with de-novo stone formation. Early detection of donor-gifted stones can allow stones to be removed at the time of transplantation. Close follow up of both living donors and transplant recipients is necessary to ensure long-term safety is maintained.